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Ability of a nurse specialist to diagnose simple headache disorders compared with consultant neurologists

¹ Academic Department of Neurology, University of Birmingham and Department of Neurology, Sandwell and West Birmingham Hospitals Trust, City Hospital, Birmingham, UK
² Department of Neurology, Sandwell and West Birmingham Hospitals Trust, City Hospital, Birmingham
³ Department of Statistics, Institute of Child Health, University of Birmingham
⁴ Department of Primary Care and General Practice, University of Birmingham

Correspondence to:
Correspondence to:
Dr C E Clarke
Department of Neurology, City Hospital, Dudley Road, Birmingham B18 7QH, UK; c.e.clarke{at}bham.ac.uk

ABSTRACT
Objective: To compare the ability of a headache nurse specialist and consultant neurologists in diagnosing tension-type headache and migraine.

Methods: An experienced neurology ward sister was trained in the differential diagnosis of headache disorders. Over six months, patients with non-acute headache disorders and role players trained to present with benign or sinister headaches were seen by both the nurse and a consultant neurologist. Both reached independent diagnoses of various headache disorders.

Results: Consultants diagnosed 239 patients with tension-type headache (47%), migraine (39%), or other headache disorders (14%). The nurse agreed with the consultant in 92% of cases of tension-type headache, 91% of migraine, and 61% of other diagnoses. Where the nurse did not agree with the diagnosis, most would have been referred for a consultant opinion. Both the nurse and the doctors misdiagnosed the same three of 13 role players. The investigation rate of the consultants varied between 18% and 59%. Only one clinically relevant abnormality was found on head scans and this was strongly suspected clinically.

Conclusions: A headache nurse specialist can be trained to diagnose tension-type headache and migraine. A nationwide nurse led diagnostic headache service could lead to substantial reduction in neurology waiting times.

Keywords: clinical nurse specialist; headache

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